Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience

Zhu, Jingjing; Jiang, Fan; Li, Pu; Shao, Pengfei; Liang, Chao; Xu, Aiming; Miao, Chenkui; Qin, Chao; Wang, Zengjun; Chen, Yin

doi:10.1186/s12894-017-0272-9

Cited by 5 publications

(12 citation statements)

References 13 publications

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“…We strive to dissect the branch arteries of the tumor, at least dissecting to the “secondary” arteries. However, not every patient could be dissected of “tertiary” renal blood vessels [35] . Strictly speaking, the ideal “zero ischemia” is unrealistic, and IRI from part of normal nephrons remains inevitable.…”

Section: Discussionmentioning

confidence: 99%

The correlation between affected renal function and affected renal residual volume

Chen

Jiang

et al. 2019

Medicine

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Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.

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Section: Discussionmentioning

confidence: 99%

The correlation between affected renal function and affected renal residual volume

Chen

Jiang

et al. 2019

Medicine

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“…With the development of robot-assisted platform and minimally invasive surgery techniques, the one-time resection of MIRTs with nephron sparing is becoming possible. Warm ischemia (WI) injury plays a principal role that influences the postoperative function outcomes in NSS, and the time of WI should be less than 20 min [15, 22]. Currently, many novel techniques have emerged to decrease WI injury, which are laudable endeavors [11–15, 23–26].…”

Section: Discussionmentioning

confidence: 99%

“…independently through a transperitoneal approach [17, 18]. The standard SRA clamping technique was described in our previous studies on LPN [11–15]. Before operation, an additional DSCT was taken out to establish three-dimensional (3D) dynamic renal vascular models for every case (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The placement of five ports in the abdomen region (Additional file 2: Figure S2B) and subsequently docking with the DaVinci robot arms (Intuitive Surgical, Sunnyvale, CA, USA) were same as previously reported by other centers [17, 18]. When the MRA was identified at the renal hilum, further dissection was performed to isolate target SRAs for precisely clamping with neurosurgical bulldogs [11–15] (Fig. 1b).…”

Section: Methodsmentioning

confidence: 99%

“…In order to further optimize the surgery treatment of MIRTs, we originally propose a novel clamping procedure of lesion-feeding arteries in RPN, the sequential clamping of precise segmental renal arteries (SRAs) [14]. Under the guidance of dual-source computed tomography (DSCT) [11–14], the technique has been successfully applied in the procedure of laparoscopic partial nephrectomy (LPN) for the treatment of MIRT in our center since 2010 and reported in 2017 [15]. But precise hilar microdissection required by sequential SRA clamping and one-time resection/renorrhaphy for multiple renal tumors are two major challenges of the technique in laparoscopic procedure.…”

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted partial nephrectomy with sequential clamping of segmental renal arteries for multiple ipsilateral renal tumors: initial outcomes

et al. 2019

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Background To assess the technical feasibility and outcomes of robotic-assisted partial nephrectomy (RPN) with sequential segmental renal artery (SRA) clamping for multiple ipsilateral renal tumors (MIRTs). Methods From April 2016 to February 2018, consecutive eleven cases successfully underwent RPN with sequential SRA clamping under the guidance of dual-source computed tomography (DSCT). Results Ten cases had two lesions and two cases had three at the ipsilateral kidneys. The mean size and the mean R.E.N.A.L score for the dominant lesion of single case were 3.3 cm and 5.7, respectively. Twenty-two lesions (84.6%) had one target SRA and four (15.4%) had two target SRAs. Satisfactory ischemic areas were achieved by sequentially clamping two (81.8%) or three (18.2%) target SRAs with mean clamping time of 18.8 (15.0–27.0) min for single lesion, and the mean of total clamping time for single case was 37.5 (32.0–52.0) min. Only the complications of grade 1–2 were found and no positive surgical margin was discovered. The mean follow-up time was 5.4 months and no local recurrence or metastasis was found. The mean postoperative eGFR was 71.2 ml/minute/1.73m 2 that was only an insignificant reduction (9.3%) compared with the preoperative baseline. Conclusion This novel nephron-sparing technique, RPN with sequential SRA clamping, represents a good alternative for selected patients with MIRTs. With the guidance of DSCT and skilled robotic experience, this technique is feasible and can maximize renal function preservation. Large-scale multicenter clinical studies are still needed to further prove these initial outcomes. Electronic supplementary material The online version of this article (10.1186/s12894-019-0451-y) contains supplementary material, which is available to authorized users.

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The efficacy evaluation of partial nephrectomy with selective renal artery branch occlusion by laparoscopy

Wang

Zhang

et al. 2021

Medicine

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Background: To investigate the clinical application and effect of laparoscopic partial nephrectomy with renal artery branch occlusion in the treatment of early renal tumors. Methods: A retrospective analysis was conducted on the clinical data of 15 cases of renal tumor patients who underwent partial nephrectomy by laparoscopic selective renal artery branch occlusion in our department from January 2017 to January 2018. Nine male patients and 6 female patients were aged 46 to 65 years, with an average age of 54.3 ± 7.2 years. The diameters of tumors were 2.2 to 4.0 cm, with an average of 3.3 ± 0.7 cm. There are 10 tumors locating on the left side and 5 on the right side. Preoperative renal glomerular filtration rate (GFR) were 77.3 to 61.9 mL/min with an average of 47.6 ± 7.5 mL/min. All patients’ diseased kidneys underwent renal computer tomography angiography examination before surgery. And the diseased kidney underwent reexamination of renal GFR. The operation time, renal artery branch occlusion time, intraoperative blood loss, postoperative hospital stay, changes of renal function, and complications were evaluated. Results: All surgery were completed successfully, the surgery time was 136.7 ± 15.2 min, intraoperative renal artery branch occlusion time was 21.3 ± 4.5 min, the intraoperative blood loss was 223.3 ± 69.5 mL, the postoperative hospital stay was 6.5 ± 1.7 days, and the postoperative 1-month GFR was 49.5 ± 6.6 mL/min. There was no significant difference between the renal GFR before and after surgery ( P > .05). There was no blood transfusion and transfer open surgery cases. The patients were followed up for 3 to 15 months without complications. Conclusions: Partial nephrectomy with selective renal artery branch occlusion by laparoscopy is a safe, feasible, and effective method for the treatment of early renal cancer. It makes good use of the technical advantages of clear operation field and fine operation of laparoscopic surgery, avoids the heat ischemia process of the whole kidney, and can better protect the renal function.

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Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience

Cited by 5 publications

References 13 publications

The correlation between affected renal function and affected renal residual volume

The correlation between affected renal function and affected renal residual volume

Robotic-assisted partial nephrectomy with sequential clamping of segmental renal arteries for multiple ipsilateral renal tumors: initial outcomes

The efficacy evaluation of partial nephrectomy with selective renal artery branch occlusion by laparoscopy

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